RA Messages for May 10, 2005

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

ROUTINE CIRCUMCISIONS WILL NO LONGER BE PAYABLE EFFECTIVE APRIL 21, 2005. ALL MEDICALLY NECESSARY CIRCUMCISIONS WILL CONTINUE TO BE PAYABLE.

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ATTENTION ANESTHESIA PROVIDERS

WE HAVE CORRECTED THE LOGIC THAT PREVENTED PAYMENT OF ANESTHESIA ADMINISTERED FOR TUBAL STERILIZATION FOLLOWING A VAGINAL DELIVERY ON THE SAME DATE OF SERVICE. CLAIMS THAT INCORRECTLY DENIED 617 WILL BE RECYCLED ON THE RA OF APRIL 26, 2005. 

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ATTENTION ALL ASC PROVIDERS

INAPPROPRIATE PRICING FOR AMBULATORY SURGICAL CENTER FEES HAS BEEN CORRECTED.ADJUSTED CLAIMS FOR STATE FISCAL YEARS 2003-2004 AND 2004-2005 WILL APPEAR ON THE PROVIDER RA OF MAY 10, 2005. 

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ATTENTION ALL PROFESSIONAL SERVICES PROVIDERS

MEDICAID POLICY FOR REIMBURSEMENT OF MULTIPLE SURGICAL PROCEDURES ALSO APPLIES TO MULTIPLE UNITS OF CPT CODES 10000-69990. WHEN MORE THAN ONE UNIT IS BILLED, THE FIRST UNIT IS PAID AT 100% AND ALL SUBSEQUENT UNITS ARE PAID AT 50%.THIS REIMBURSEMENT LOGIC WAS OVERLOOKED WHEN THE ENHANCED REIMBURSEMENT FOR RECIPIENTS AGE 0-10 WAS ORIGINALLY IMPLEMENTED. WE RECENTLY BECAME AWARE OF THIS OVERSIGHT, HAVE CORRECTED THE LOGIC AND COMPLETED THE ADJUSTMENT OF CLAIMS BACK TO DATE OF SERVICE 1/1/2003. ADJUSTMENTS APPEARED ON THE REMITTANCE ADVICE OF 5/3/2005. 

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ATTENTION ALL PROFESSIONAL SERVICES PROVIDERS

WE ARE PLEASED TO ANNOUNCE AN INCREASE IN FEES RETROACTIVE TO DATE OF SERVICE 1/1/2004 FOR SURGICAL SERVICES (CPT 10021-69990; EXCLUDING PROCEDURE CODES FOR DELIVERIES) FOR RECIPIENTS AGE 11-15 AND SELECT MEDICAL SERVICES (CPT 90918-99199) FOR RECIPIENTS AGE 0-15. PROVIDERS MSY CHOOSE TO SUBMIT ADJUSTMENTS OR MONITOR THE REMITTANCE ADVICES FOR A DEPARTMENTAL ADJUSTMENT OF CLAIMS AT A FUTURE DATE. 

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ATTENTION LTC PROVIDERS
NURSING HOME FACILITIES, ICF-MR FACILITIES, HOSPICE, AND ADHC PROVIDERS

EFFECTIVE JUNE 9, 2005 AT 12 NOON, UNISYS WILL NO LONGER ACCEPT ANY LTC CLAIMS BILLED ON A TAD. THIS BILLING CHANGE ALSO APPLIES TO BILLING FOR PRIOR DATES OF SERVICES. ALL SUPPLEMENTAL BILLING MUST BE SUBMITTED ELECTRONICALLY OR ON THE UB-92 HARD COPY CLAIM FORM. ANY TADS RECEIVED BY UNISYS AFTER JUNE 9, 2005 WILL BE RETURNED TO THE PROVIDER TELLING THEN TO BILL ON THE UB-92 HARD COPY CLAIM FORM. THE UB-92 HARD COPY FORM IS ALSO REPLACING THE 212 ADJUSTMENT FORM. YOU SHOULD IMMEDIATELY START USING THE UB-92 FORM, SINCE THE 212 ADJUSTMENT WILL BECOME OBSOLETE IN THE NEAR FUTURE. YOU MUST CONTINUE TO SUBMIT PLI ADJUSTMENTS ON THE 148-PLI ADJUSTMENT FORM. THE LAST UNISYS GENERATED TADS WILL BE FOR MAY,2005 DATES OF SERVICES. IT IS IMPERATIVE THAT YOU BEGIN SUBMITTING CLAIMS ELECTRONICALLY USING THE MANDATED X12 837I FORMAT OR HARD COPY USING THE UB-92 CLAIM FORM PRIOR TO THE EFFECTIVE CUTOFF DATE TO PREVENT DELAYS IN PAYMENT. PLEASE CALL UNISYS EDI FOR ASSISTANCE WITH ELECTRONIC BILLING  (225-237-3318) AND PROVIDER RELATIONS FOR ASSISTANCE WITH UB-92 BILLING (800)473-2783 OR (225) 924-5040. 

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LTC AND HOSPICE PROVIDERS

LTC AND HOSPICE PROVIDERS WILL NOTICE A MINOR DIFFERENCE IN THE WAY DHH HANDLES HOSPICE CASES. MEDICAID FIELD STAFF ARE NO LONGER RESPONSIBLE FOR ENTERING HOSPICE SEGMENTS INTO THE MEDICAID INFORMATION SYSTEM. THIS WILL BE HANDLED BY DHH HOSPICE STAFF IN PROGRAM OPERATIONS AT DHH HEADQUARTERS IN BATON ROUGE. THE BHSF FORM 148 GENERATED BY THE LTC PROVIDER, REFLECTING A RECIPIENT'S HOSPICE STATUS MUST BE FAXED TO THE STATE HOSPICE UNIT AT 225-342-1411. LTC PROVIDERS PLEASE CONTINUE TO SEND THE FORM 148 TO THE MEDICAID ANALYSTS IN THE PARISH OFFICES AS WELL. LETTERS TO BOTH LTC AND HOSPICE PROVIDERS NOTIFYING THEM OF THE DATE THAT A RECIPIENT IS CERTIFIED FOR HOSPICE WILL NOT BE SENT BY THE PARISH OFFICE BUT WILL BE SENT FROM DHH HEADQUARTERS. PLEASE PAY CLOSE ATTENTION TO THIS DATE. HOSPICE PROVIDERS WILL NEED TO CONTACT THE LTC PROVIDERS FOR PLI AMOUNTS. LTC PROVIDERS THAT HAVE BEEN PAID FOR DAYS AFTER THE DAY IN WHICH HOSPICE WAS CERTIFIED MUST EITHER VOID OR ADJUST THOSE CLAIMS TO ENSURE THAT THEY ARE NOT PAID FOR DAYS IN WHICH THE HOSPICE PROVIDER IS RESPONSIBLE FOR THAT PATIENT. FEDERAL REGULATIONS REQUIRE THAT ALL HOSPICE PAYMENTS BE MADE TO THE HOSPICE PROVIDERS, INCLUDING THE ROOM AND BOARD. THE HOSPICE PROVIDER IS RESPONSIBLE FOR PASSING THIS PAYMENT THROUGH TO THE LTC PROVIDER. LTC PROVIDERS THAT DO NOT CORRECT CLAIMS ARE SUBJECT TO ADMINISTRATIVE SANCTIONS BY DHH AND/OR THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). HOSPICE PROVIDERS, PLEASE WORK CLOSELY WITH LTC PROVIDERS TO ENSURE THAT PAYMENTS ARE HANDLED APPROPRIATELY AND WITHIN THE FEDERAL GUIDELINES.